Parent J M, Lowenstein D H
Department of Neurology, University of California, San Francisco 94143.
Neurology. 1994 Oct;44(10):1837-40. doi: 10.1212/wnl.44.10.1837.
The optimal therapeutic approach for the patient with refractory generalized status epilepticus remains to be defined. We describe four patients with refractory generalized status epilepticus who were successfully treated with intravenous midazolam. Each patient had prolonged convulsive status epilepticus unresponsive to standard doses of intravenous benzodiazepines, phenytoin, and phenobarbital. The patients subsequently received midazolam administered as an intravenous bolus (200 micrograms/kg) followed by a continuous infusion (0.75 to 11 micrograms/kg/min) lasting 8 hours to 10 days. Clinical examination and scalp electroencephalographic monitoring documented the cessation of seizure activity within minutes of the loading dose in all patients. No significant adverse effects occurred during midazolam treatment. The one patient with prolonged midazolam infusion required fluid boluses and pressors for moderate hypotension, and the remainder of the patients safely tolerated midazolam despite preexistent hemodynamic instability. All patients recovered and maintained good seizure control. Intravenous midazolam appears to be an effective treatment for refractory generalized status epilepticus, and may represent a substantial improvement over current therapeutic approaches such as pentobarbital anesthesia.
难治性全面性癫痫持续状态患者的最佳治疗方法仍有待确定。我们描述了4例难治性全面性癫痫持续状态患者，他们通过静脉注射咪达唑仑成功得到治疗。每名患者的惊厥性癫痫持续状态均持续较长时间，对标准剂量的静脉注射苯二氮䓬类药物、苯妥英钠和苯巴比妥均无反应。这些患者随后接受了静脉推注咪达唑仑（200微克/千克），随后持续输注（0.75至11微克/千克/分钟），持续8小时至10天。临床检查和头皮脑电图监测记录显示，所有患者在负荷剂量给药后的数分钟内癫痫活动停止。咪达唑仑治疗期间未出现明显不良反应。1例接受长时间咪达唑仑输注的患者因中度低血压需要静脉补液和使用升压药，其余患者尽管存在血流动力学不稳定的情况，但对咪达唑仑耐受良好。所有患者均康复且癫痫得到良好控制。静脉注射咪达唑仑似乎是治疗难治性全面性癫痫持续状态的有效方法，可能比目前的治疗方法如戊巴比妥麻醉有显著改进。
